| NPI | 1831893254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 865930) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: NV 865930) |
| Enumeration Date | 2023-03-29 |
| Last Update Date | 2023-05-30 |